A nurse is assessing the level of consciousness of a patient who has sustained a head injury in a motor vehicle accident. The nurse notes that the patient appears drowsy but the nurse is able to wake the patient by gently shaking and calling the patient by name. What level of consciousness would the nurse document?
Comatose
Stuporous
Lethargic
Awake and Alert
The Correct Answer is C
A. Comatose:
A comatose state is characterized by an unarousable and unresponsive condition. Individuals in a coma do not respond to external stimuli, including shaking or calling their name.
B. Stuporous:
Stupor is a state of near-unconsciousness or insensibility. A stuporous patient may require more intense stimulation to achieve a response than someone who is lethargic.
C. Lethargic:
Lethargy is a state of drowsiness or fatigue. Lethargic patients may appear drowsy but can be awakened by gentle stimulation, such as shaking and calling their name.
D. Awake and Alert:
An awake and alert state implies full responsiveness, awareness, and orientation to the environment. The patient in the scenario does not fit this description.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. 20 bpm: This is twice the calculated rate, so it's significantly higher than observed.
B. 10 bpm: This matches closely with the calculated rate of approximately 10.23 breaths per minute.
The scenario describes the nurse counting the client's breaths starting from when the second hand of the clock was at 12 and ending just past 5, and the client completed 9 breaths during this time frame.
Counting Period:
From just past 12 to just past 5 on the clock, the time span is approximately 53 seconds.
Number of Breaths:
The client completed 9 breaths within this time frame.
Now, to calculate the respiratory rate:
Respiratory rate = (Number of breaths / Time in minutes)
Respiratory rate = (9 breaths / 0.88 minutes) (53 seconds converted to minutes)
After calculation, the respiratory rate is approximately 10.23 breaths per minute.
C. 09 bpm: This is a lower value than observed and doesn't align with the counted breaths.
D. 18 bpm: This is close to double the observed rate, which doesn't match with the counted breaths within the time frame.
Correct Answer is A
Explanation
A. Defining the legal scope of nursing practice:
The nurse practice act in each state defines the scope of practice for nurses, outlining what nurses can and cannot do within the legal boundaries of their profession. It specifies the duties, responsibilities, and limitations of nursing practice within that particular state.
B. Lobbying federal lawmakers to advance professional nursing:
While nursing organizations and associations may engage in lobbying efforts at the federal level, it's not a direct component of the state's nurse practice act.
C. Providing continuing education programs:
While states might require nurses to participate in continuing education for license renewal, the provision of continuing education programs itself is not a direct element of the nurse practice act.
D. Creating institutional policies for health care practices:
Institutional policies are typically developed by healthcare institutions or organizations and are separate from the state's nurse practice act.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
